Examination of Physiological Changes Seen in Workers Using Breathing Masks During COVID-19 Pandemic

Background: There are very few studies in the literature evaluating the effects of mask use on physiological parameters. Objectives: This study aims to examine physiological changes due to masks in healthcare workers who use respiratory masks for long hours in the emergency room during the pandemic process. Methods: Cross-sectional and prospective study was carried out with healthcare professionals with an FFP2 type valve mask. The participants’ transcutaneous oxygen saturation, pulse, and respiratory rate were measured before wearing the respirator mask and at 30 and 60 minutes after wearing the mask. Results: SPO2 values of the participants decreased gradually at 0th, 30th, and 60th minutes and respiratory rate increased gradually at 0th, 30th, and 60th minutes. The statistically significant difference arises from the 0 and 60 minutes values. Higher SPO2 values were found at 0 and 30 minutes in non-smokers. SPO2 value gradually decreased in non-smokers at 0, 30, and 60 minutes, but no significant decrease was observed in non-smokers. Pulse rate was found to be higher at 60th minute compared to 0th minute in non-smokers. No significant difference was found between smokers and non-smokers. The respiratory rate gradually increased in smokers at 0th, 30th, and 60th minutes. SPO2 values were lower at the 60th minute compared to the 0th minute in both women and men. There was no significant difference in pulse rates. Respiratory rate was found to be higher at 60th minute in men than at 0th minute. Conclusion: It is recommended to follow the physiological parameters and to regulate the working conditions when necessary.

Safety of conscious sedation in electroanatomical mapping procedures and cryoballoon pulmonary vein isolation

Immobilization of patients during electrophysiological procedures, to avoid complications by patients’ unexpected bodily motion, is achieved by moderate to deep conscious sedation using benzodiazepines and propofol for sedation and opioids for analgesia. Our aim was to compare respiratory and hemodynamic safety endpoints of cryoballoon pulmonary vein isolation (PVI) and electroanatomical mapping (EAM) procedures. Included patients underwent either cryoballoon PVI or EAM procedures. Sedation monitoring included non-invasive blood pressure measurements, transcutaneous oxygen saturation (tSpO2) and transcutaneous carbon-dioxide (tpCO2) measurements. We enrolled 125 consecutive patients, 67 patients underwent cryoballoon atrial fibrillation ablation and 58 patients had an EAM and radiofrequency ablation procedure. Mean procedure duration of EAM procedures was significantly longer (p < 0.001) and propofol doses as well as morphine equivalent doses of administered opioids were significantly higher in EAM patients compared to cryoballoon patients (p < 0.001). Cryoballoon patients display higher tpCO2 levels compared to EAM patients at 30 min (cryoballoon: 51.1 ± 7.0 mmHg vs. EAM: 48.6 ± 6.2 mmHg, p = 0.009) and at 60 min (cryoballoon: 51.4 ± 7.3 mmHg vs. EAM: 48.9 ± 6.6 mmHg, p = 0.07) procedure duration. Mean arterial pressure was significantly higher after 60 min (cryoballoon: 84.7 ± 16.7 mmHg vs. EAM: 76.7 ± 13.3 mmHg, p = 0.017) in cryoballoon PVI compared to EAM procedures. Regarding respiratory and hemodynamic safety endpoints, no significant difference was detected regarding hypercapnia, hypoxia and episodes of hypotension. Despite longer procedure duration and deeper sedation requirement, conscious sedation in EAM procedures appears to be as safe as conscious sedation in cryoballoon ablation procedures regarding hemodynamic and respiratory safety endpoints.

A boy with refractory cyanosis: pediatric pulmonary arteriovenous malformation case report and literature review

Background: Pulmonary arteriovenous malformation is rare and is defined as the presence of an abnormal connection between the pulmonary artery and vein. Pulmonary arteriovenous malformation can manifest with no obvious clinical symptoms and is only found incidentally on pulmonary imaging examinations. The clinical signs vary according to the shunt flow in proportion to the malformation area. In severe cases, symptoms such as exertional dyspnea, cyanosis, hemoptysis or even sudden death can occur. Untreated pulmonary arteriovenous malformation may result in cardiac failure or rupture of the aneurysmal fistula.Case presentation: We report the case of a 1-year-old boy who presented with refractory cyanosis and a transcutaneous oxygen saturation level of 70-76%.Pulmonary arteriovenous malformation was detected on computed tomography angiogram. We chose surgical resection of the diseased lung as the treatment. The boy had a good prognosis and was followed up for 3 months without recurrence. The analysis of this case and a review of the literature improved our understanding of pulmonary arteriovenous malformation.Conclusion: Pulmonary arteriovenous malformation should be considered when unexplained conditions such as hypoxia and hemoptysis are encountered or when pulmonary arteriovenous malformation-like mass changes are visible on chest imaging. The early identification of the problem, diagnosis, treatment and follow-up are helpful for reducing trauma and for improving the long-term outcome of children with pulmonary arteriovenous malformation.

Novel Input for Designing Patient-Tailored Pulmonary Rehabilitation: Telemonitoring Physical Activity as a Vital Sign—SMARTREAB Study

Physical inactivity may be a consequence of chronic diseases but also a potential modifiable risk factor. Therefore, it should be clinically assessed as a vital sign of patients’ general physical condition prior to any exercise-based intervention. This cross-sectional study describes physical activity in the daily life of 100 chronic respiratory patients before pulmonary rehabilitation, comparing subjective and objective measures. The assessment combined the International Physical Activity Questionnaire (IPAQ) and 4-day accelerometer and oximeter telemonitoring with SMARTREAB technology, assessing heart rate, transcutaneous oxygen saturation and activity-related energy expenditure by metabolic equivalent of task (MET). According to IPAQ, 49% of patients had a moderate level of physical activity in daily life (PADL), a weekly mean level of 2844 ± 2925 MET.min/week, and a mean sedentary time of 5.8 ± 2.7 h/day. Alongside this, SMARTREAB telemonitoring assessed maximum activity ranging from 1.51 to 4.64 METs, with 99.6% daytime spent on PADL below 3 METs and 93% of patients with daily desaturation episodes. Regardless of the self-reported IPAQ, patients spend at least 70% of daytime on PADL below 2 METs. SMARTREAB was demonstrated to be an innovative methodology to measure PADL as a vital sign, combining oximetry with accelerometry, crossmatched with qualitative patient data, providing important input for designing patient-tailored pulmonary rehabilitation.

Implementation and adherence to the Bedside Paediatric Early Warning System (BedsidePEWS) in a pediatric tertiary care hospital

Background Escalation of care in deteriorating children admitted to hospital wards in relation to pediatric early warning scores has been rarely reported. The aim of this study is to examine adherence to the vital signs and BedsidePEWS escalation protocol at a large tertiary care children’s hospital.Methods This is a prospective observational study. A 6-month audit on adherence to BedsidePEWS was performed on the wards in 2018. Data on the frequency and accuracy of BedsidePEWS score calculations, escalation of patient observations, monitoring and medical reviews were recorded.Two research nurses performed weekly visits to the hospital wards to collect data on BedsidePEWS scores, medical reviews, type of monitoring and vital signs recorded. Data were described through means or medians according to the distribution. Inferences were calculated either with Chi-square, Student’s t test or Wilcoxon-Mann–Whitney test, as appropriate (P <0.05 considered as significant).Results A total of 522 Vital Signs (VS) and score calculations on 177 patient clinical records were observed from 13 hospital inpatient wards. Frequency of VS and score documentation occurred <3 times per day in 33% of the observations. Adherence to the VS documentation frequency according to the hospital protocol was observed in 54% for all patients; for children with chronic health conditions (CHC) it was significantly lower than children admitted for acute medical conditions (47%, P=0.006). The BedsidePEWS score was correctly calculated and documented in 84%, systolic blood pressure was recorded in 79% and temperature in 91% of the VS recording events. Patients within a 0-2 BedsidePEWS score range were all reviewed at least once a day by a physician. Only 50% of the patients in the 5-6 score range were reviewed within 4 hours and 42% of the patients with a score ≥7 within 2 hours. Transcutaneous Oxygen Saturation continuous monitoring was applied to 60% of the children at higher risk (BedsidePEWS ≥5).Conclusions Escalation of patient observations, monitoring and medical reviews matching the BedsidePEWS is still suboptimal. Children with CHC are at higher risk of lower compliance. Impact of adherence to predefined response algorithms on patient outcomes should be further explored.

TISSUE OXYGEN LEVEL IN ACUTE AND CHRONIC WOUND: A COMPARISON STUDY

Adequate oxygen supply to granulating tissue and its surroundings is considered as an elementary factor to render an optimum condition for proper wound healing. This paper focused on comparing the quantitative mean of transcutaneous oxygen saturation (StO2) between acute superficial wounds and chronic diabetic wounds in a randomized clinical study. A multispectral imaging system was employed for in-vivo measurement of wound StO2 across a visible wavelength range of nm. Processed StO2 maps of wounds using a reconstructed mathematical model revealed a mean StO2 of and , respectively, in acute and chronic wounds. The statistical test on the difference in the values between these two groups of wounds was shown to be statistically significant (). These crucial findings contribute to the existing knowledge on the StO2 range and its variation in different wound conditions. In conclusion, the proposed multispectral imaging system is able to produce clinical information of wound oxygenation level for a better understanding of the obligatory role of oxygen as a key determinant in healing outcomes.

Corona virus disease 2019: hysteresis effect of chest CT and the correlation of its severity with lymphocyte count in peripheral blood

Background Chest computed tomography (CT) has been accepted to provide reference for the diagnose and assessment the severity of Corona Virus Disease 2019 (COVID-19). Decrease in the counts of lymphocyte and leukocyte is used as the diagnostic indicator of suspected COVID-19 cases. However, there is few study on exploring the hysteresis of chest CT changes and the predictive role of lymphocyte count in peripheral blood before treatment in the severity of the disease. Methods A retrospective analysis was carried out focusing on the data of patients tested to be positive for RNA nucleic acid test of SARS-CoV-2 with nasopharyngeal swabs in 4 hospitals. An independent assessment was performed by one clinician using the DEXIN FACT Workstation Analysis System, and the assessment results were reviewed by another clinician. Furthermore, the mean hysteresis time was calculated according to the median time from progression to the most serious situation to improvement of chest CT in patients after fever relief. The optimal scaling regression analysis was performed by including variables with statistical significance in univariate analysis. In addition, a multivariate regression model was established to investigate the relationship of the percentage of lesion/total lung volume with lymphocyte and other variables. Results In the included 166 patients with COVID-19, the average value of the most serious percentage of lesion/total lung volume was 6.62, of which 90 patients with fever had an average hysteresis time of 4.5 days after symptom relief, with a similar trend observed in those without fever. Multivariate analysis revealed that lymphocyte count in peripheral blood and transcutaneous oxygen saturation decreased with the increase of the percentage of lesion/total lung volume. Meanwhile, age, fever and C-reactive protein exhibited no such effect in the established model. Conclusions There is a hysteresis effect in the improvement of chest CT image in relative to fever relief in patients with COVID-19. Besides, the percentage of lesion/total lung volume of chest CT correlates negatively with lymphocyte count in peripheral blood and transcutaneous oxygen saturation. Findings in our study may contribute to understanding the disease status of patients with COVID-19 and grasping the opportunity of treatment by clinicians.

Transcutaneous Oxygen Saturation Accuracy in Critically Ill Children

Background Pulse oximetry (SpO 2 ) is used to monitor oxygen saturation levels to avoid hypoxaemia in children. Sensor manufacturers claim high sensitivity, specificity and accuracy. Few studies have evaluated accuracy and precision of SpO 2 in children. Methods This prospective, observational study was conducted in a 36-bed mixed medical/surgical paediatric intensive care unit. All children <16 years old with an arterial line were eligible. Paired SpO 2 readings obtained with a Masimo and a Nellcor sensor were prospectively matched and validated to the arterial haemoglobin oxygen saturation (SaO 2 ). Bias between SpO 2 and SaO 2 (SpO 2 -SaO 2 ), accuracy root mean square (A rms ), sensitivity, specificity and kappa agreement were calculated for sensors. Multivariable regression analysis was conducted to determine the relationship between clinical variables and bias in paired sensor readings. Findings There were 929 participants with 16,839 readings (9,382 simultaneous Masimo and Nellcor). Nineteen percent of paired values had SaO 2 <88%. Bias increased with decreasing SaO 2 . Both sensors failed to achieve FDA’s A rms requirement in all ranges. Of the 15.5% patients with ‘true hypoxaemia’ (SaO 2 <88%), 28.6% (n=1165) were not correctly identified by pulse oximetry. Variables associated with higher odds of bias included sepsis, respiratory distress and post-cardiac arrest; increasing lactate; vasoconstrictor use; lower SaO 2 and low admission weight. Interpretation Both tested sensors, with current algorithms, are not precise enough for a PICU setting. Sensor readings in patients with respiratory disease, sepsis and cardiac arrest should be used with caution.